Provider Demographics
NPI:1689988842
Name:MCRAE, STEVEN ALEXANDER (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALEXANDER
Last Name:MCRAE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-4259
Mailing Address - Country:US
Mailing Address - Phone:770-823-4048
Mailing Address - Fax:
Practice Address - Street 1:3200 DOWNWOOD CIR NW STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1659
Practice Address - Country:US
Practice Address - Phone:404-352-4500
Practice Address - Fax:404-350-0722
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant